Rational Thinking Score

Category: General CBT Topics

  • If Everyone Likes You, You Do Not Know Very Many People

    If Everyone Likes You, You Do Not Know Very Many People

    By Dr, Aldo Pucci

    People often act as if they believe they have a need to be liked. They demonstrate that belief by making themselves miserable when someone does not like them or when someone has something negative to say about them. While being liked might be needed for some specific purpose (like to win a popularity contest), our survival obviously does not depend on it.

    Furthermore, often times not being liked is not even a problem for us, we only think that it is. For example, if someone dislikes me who is irrelevant to my life and my goals, their disliking me is not even a problem for me let alone something that is horrible or catastrophic. So if it is not a problem, there is not much point to even spend much time thinking about their disapproval. Who cares? It is irrelevant.

    But people have been brainwashed into thinking that they must have everyone’s approval and that it is a catastrophe if someone does not. It’s time to get over that nonsense. Some people matter much more to you than others do. Some people, if they acted on their negative opinions of you, will have a greater impact on your life and your goals. But even with that, there is no need to make yourself miserable over the results of their acting on their opinions, if they do.

  • Bridging the Gap: How CBT and Behaviour Cards Empower Individuals with Autism

    Bridging the Gap: How CBT and Behaviour Cards Empower Individuals with Autism

    Bridging the Gap: How CBT and Behaviour Cards Empower Individuals with Autism

    Introduction

    Navigating the world can be a complex journey for anyone, but for individuals on the autism spectrum, it often presents a unique set of challenges. Beyond the core characteristics of autism itself, many autistic children and adolescents frequently experience co-occurring mental health conditions like anxiety, panic attacks, and depression. These additional struggles can significantly impact their well-being and daily functioning. Fortunately, Cognitive Behavioral Therapy (CBT) has emerged as a powerful and adaptable therapeutic approach to help address these issues. When tailored to meet the specific learning and communication styles of autistic individuals, CBT, often enhanced by practical visual tools such as behaviour cards, provides a structured pathway to understanding and managing challenging thoughts, feelings, and behaviors. This article delves deeper into how CBT is applied to treat these conditions and the vital role that behaviour cards play in empowering autistic youth. For individuals on the autism spectrum, navigating the complexities of social interactions, emotional regulation, and unexpected changes can often lead to significant challenges. While autism is a neurodevelopmental condition, not a mental illness, people with autism are at a higher risk of experiencing co-occurring mental health conditions like anxiety, depression, and obsessive-compulsive disorder. This is where Cognitive Behavioral Therapy (CBT) steps in, often enhanced by practical tools like “behaviour cards,” to provide valuable support.

    Understanding Cognitive Behavioral Therapy (CBT)

    CBT is a widely recognized and evidence-based psychotherapy that focuses on the interconnectedness of thoughts, feelings, and behaviors. The core principle is that by identifying and changing unhelpful thinking patterns (cognitions) and maladaptive behaviors, individuals can improve their emotional state and overall well-being.

    For autistic individuals, CBT is typically adapted to accommodate their unique cognitive styles and communication preferences. Traditional “talk therapy” approaches might be less effective for someone who processes information visually or struggles with abstract concepts. Therefore, CBT for autism often incorporates:

    1. Visual Aids: Charts, diagrams, social stories, and visual schedules help illustrate concepts and sequences.
    2. Structured Sessions: A clear, predictable format minimizes anxiety and helps maintain focus.
    3. Concrete Examples: Abstract ideas are broken down into specific, tangible situations.
    4. Special Interests: Incorporating a person’s specific interests can enhance engagement and motivation.
    5. Focus on Skills: Emphasis is placed on teaching practical coping strategies and problem-solving skills.

    CBT has shown promise in helping autistic individuals manage anxiety, improve social skills, regulate emotions, and address rigid thinking patterns. It empowers them to better understand their internal experiences and develop healthier responses to challenging situations.

    The Role of Behaviour Cards

    Behaviour cards, also known as cue cards, visual reminders, or social prompts, are highly effective visual supports that complement CBT principles for individuals with autism. They serve as a bridge between abstract therapeutic concepts and concrete, actionable steps.

    Here’s how behaviour cards contribute:

    1. Visual Reinforcement: Many autistic individuals are strong visual learners. Behaviour cards provide clear, concise visual cues that reinforce desired behaviors or strategies learned in CBT. For example, a card showing a calming technique (like deep breathing) can be a quick reminder during a stressful moment.
    2. Non-Verbal Communication: In situations where verbal communication is difficult or overwhelming, behaviour cards offer a non-verbal way to prompt a desired action or remind an individual of a social rule. A card with a “quiet voice” image can be shown discreetly in a noisy environment.
    3. Promoting Independence: By providing a tangible reference, behaviour cards help individuals internalize strategies and use them independently. Instead of relying solely on verbal prompts from others, they can consult their cards.
    4. Managing Transitions and Unexpected Changes: Cards depicting a sequence of activities or offering options for coping with change can reduce anxiety during transitions, a common challenge for many autistic individuals.
    5. Emotional Regulation: Some behaviour cards are designed to help individuals identify and manage their emotions. These might include a “feelings scale” or cards illustrating different emotions and corresponding coping strategies.
    6. Social Skills Development: Cards can illustrate expected social behaviours in various situations, such as taking turns, making eye contact, or understanding personal space. They act as visual scripts for social interactions.
    7. Token Systems: In some adapted CBT approaches, behaviour cards are used as part of a token system, where individuals earn cards as rewards for practicing new skills or managing challenging thoughts. This provides tangible reinforcement for progress.

    Practical Examples of Behaviour Cards in Use:

    1. “Break Card”: An individual feeling overwhelmed can present this card to request a break from a demanding situation.
    2. “Calm Body Card”: Visuals showing a relaxed posture or deep breaths to remind an individual to self-regulate.
    3. “First/Then Card”: “First [task to do], then [reward/preferred activity]” helps structure activities and motivate completion of less favored tasks.
    4. “Expected/Unexpected Behavior Cards”: These cards can depict different social scenarios and prompt discussions about what behavior is expected or unexpected in that context.
    5. “Thought Challenge Cards”: For older individuals, cards might present common cognitive distortions (e.g., “all-or-nothing thinking”) and prompts for reframing those thoughts.

    Conclusion

    CBT, with its emphasis on understanding the link between thoughts, feelings, and behaviors, offers a powerful framework for supporting individuals with autism. When skillfully adapted to leverage visual strengths and provide concrete tools, it can significantly improve emotional well-being and adaptive functioning. Behaviour cards serve as invaluable practical complements, translating abstract CBT concepts into accessible, actionable visual cues that empower individuals with autism to navigate their world with greater confidence and independence. As research continues to refine therapeutic approaches, the integration of such practical, visually-driven tools will remain a cornerstone of effective support for the autistic community.

    Suggested Bibliography and Key Resources for CBT, Autism, and Mental Health

    This bibliography is illustrative and represents the types of sources that would support the information presented. For a definitive academic paper, specific editions, page numbers, and publication details would be required.

    Key Researchers and Clinical Experts:

    1. Tony Attwood: A leading clinical psychologist specializing in autism spectrum disorder, particularly high-functioning autism and Asperger’s Syndrome. His work often discusses emotional regulation, anxiety, and social skills in autistic individuals. He has written extensively on CBT adaptations.
    2. Susan White: Known for her research on anxiety and CBT in autistic adolescents, often exploring evidence-based interventions.
    3. Judy Reaven: A prominent researcher focusing on anxiety in children and adolescents with autism spectrum disorder, and developing and testing CBT interventions.
    4. Jessica Kingsley Publishers (JKP): This publisher has a vast catalog of books on autism, including many practical guides and clinical manuals on CBT for autistic individuals. Many respected authors publish through JKP.
    5. Michelle Garcia Winner: Developer of the Social Thinking Methodology, which, while not strictly CBT, often complements CBT by providing frameworks for understanding social nuances that contribute to social anxiety in autistic individuals.

    Foundational Texts and Clinical Manuals (Types of Resources):

    1. Manuals for Cognitive Behavioral Therapy for Anxiety in Children and Adolescents (adapted for ASD): Look for texts specifically outlining CBT protocols for anxiety disorders (e.g., Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder) that have been adapted for children and adolescents with autism.
    2. Example type: “Coping Cat” program adaptations for ASD.
    3. Example type: “Facing Your Fears” program for children with autism.
    4. Texts on Emotion Regulation and Social Skills for Individuals with ASD: Books that delve into strategies for identifying, understanding, and managing emotions, as well as navigating social situations.
    5. Resources on Visual Supports and Communication Strategies for Autism: Books and guides detailing the effective use of visual schedules, social stories, visual cue cards, and other visual aids.

    Relevant Academic Journals:

    1. Journal of Autism and Developmental Disorders: A primary journal for research on autism, including clinical trials of interventions.
    2. Autism Research: Another key journal publishing high-quality research on autism spectrum conditions.
    3. Journal of Consulting and Clinical Psychology: Publishes research on psychological interventions, often including those adapted for specific populations.
    4. Cognitive and Behavioral Practice / Behavior Therapy: Journals focused on CBT principles and their application.

    Reputable Organizations:

    1. Autism Speaks: Provides information, resources, and supports research related to autism.
    2. Autism Society: Focuses on improving the lives of all affected by autism through advocacy, education, and support.
    3. National Autistic Society (UK): A leading UK charity providing information and support for autistic people and their families.
    4. Association for Behavioral and Cognitive Therapies (ABCT): A professional organization for CBT therapists and researchers.

    General Search Terms for Academic Databases:

    When searching for specific papers, use combinations of these terms:

    1. “CBT Autism”
    2. “Cognitive Behavioral Therapy ASD”
    3. “Anxiety Autism Treatment”
    4. “Depression Autism Therapy”
    5. “Panic Attacks Autism”
    6. “Behaviour Cards Autism”
    7. “Visual Supports CBT Autism”
    8. “Emotion Regulation Autism”
    9. “Adolescents Autism Mental Health”
    10. “Child Autism CBT”

    Further develops the topic of the CBT approach to treating panic attacks, anxiety, and depression in autistic children and adolescents.

    The challenges faced by autistic children and adolescents often extend beyond the core characteristics of autism itself. They are at a significantly higher risk of developing co-occurring mental health conditions such as panic attacks, anxiety disorders, and depression. This heightened vulnerability can be attributed to several factors, including difficulties with social communication, sensory sensitivities, challenges with routines and unexpected changes, and the sheer effort involved in navigating a world primarily designed for neurotypical individuals.

    Cognitive Behavioral Therapy (CBT), when appropriately adapted, has emerged as a leading evidence-based intervention for these co-occurring conditions in autistic youth. It offers a structured and skills-based approach that resonates well with the learning styles of many individuals on the spectrum.

    Adapting CBT for Autistic Children and Adolescents

    Effective CBT for autistic youth isn’t a one-size-fits-all solution; it requires significant adaptations to address their unique cognitive and developmental profiles. Key modifications include:

    1. Emphasis on Visual Supports:
    2. Visual Schedules: Providing a clear visual representation of the therapy session (e.g., “Hello,” “Review Homework,” “New Skill,” “Practice,” “Homework,” “Goodbye”) reduces anxiety about unpredictability.
    4. Emotion Scales/Thermos: Using visual scales (e.g., a “feelings thermometer” from 0 to 10) helps children quantify and communicate the intensity of their emotions, which can be challenging to verbalize.
    6. Social Stories and Comic Strip Conversations: These tools are excellent for breaking down complex social situations, explaining expected behaviors, and helping to understand the perspectives of others, which is crucial for managing social anxiety.
    8. Behaviour Cards: As discussed, these act as concrete reminders for coping strategies (e.g., a card showing a deep breath, a “take a break” card, or a card with a social cue like “wait for my turn”).
    9. Concrete and Direct Language:
    10. Avoiding Metaphors and Idioms: Abstract language can be confusing. Therapists use clear, literal language to explain concepts like “thoughts,” “feelings,” and “behaviors.”
    11. Breaking Down Concepts: Complex CBT concepts (e.g., cognitive distortions) are broken into smaller, more manageable parts, often using simplified language and visual examples.
    13. Incorporating Special Interests:
    14. Enhanced Engagement: Leveraging a child’s special interest (e.g., dinosaurs, Minecraft, trains) can make therapy more engaging and relatable. Examples can be tailored to their interest, and rewards can be linked to it.
    15. Motivation and Rapport: Discussing preferred interests at the beginning of sessions can help build rapport and create a safe, comfortable environment.
    16. Flexible and Patient Approach:
    17. Increased Processing Time: Autistic individuals may need more time to process information and formulate responses. Therapists allow for pauses and avoid rushing.
    18. Sensory Accommodations: Creating a sensory-friendly environment (e.g., dimming lights, providing fidgets, allowing movement breaks) can help reduce sensory overload, a common trigger for anxiety and meltdowns.
    20. Parent/Caregiver Involvement:
    21. Psychoeducation: Parents and caregivers receive extensive education about autism, anxiety, depression, and CBT principles to support skill generalization at home and school.
    22. Skill Practice: They are actively involved in practicing skills learned in therapy, creating a consistent environment for the child to apply new strategies.
    23. Collaboration: Working as a team with parents, educators, and other professionals ensures a cohesive approach to supporting the child.

    CBT for Panic Attacks in Autistic Youth

    Panic attacks are sudden, intense surges of fear that can be particularly distressing for autistic individuals due to sensory sensitivities and challenges with interoception (perceiving internal bodily states). CBT addresses panic attacks through:

    1. Psychoeducation: Explaining what a panic attack is (a false alarm from the body, not a sign of danger), including common physical sensations (racing heart, shortness of breath, dizziness) and their non-threatening nature. Visuals like a “panic attack thermometer” can illustrate the escalation of symptoms.
    3. Breathing Retraining: Teaching controlled, diaphragmatic breathing techniques is crucial. Visual cues (e.g., “smell the flower, blow out the candle,” or a visual timer for inhale/exhale) are often used to guide the child.
    4. Cognitive Restructuring: Helping children identify and challenge catastrophic thoughts associated with panic (e.g., “I’m having a heart attack,” “I’m going to die,” “I’m going crazy”). This might involve using behaviour cards with reframing statements like “This feeling will pass” or “I am safe.”
    5. Exposure Therapy: Gradually exposing the child to feared situations or bodily sensations that trigger panic, in a controlled and supportive environment. This “stepladder” approach helps habituate the child to the discomfort and realize it’s manageable. For example, if a racing heart is a trigger, the child might practice running in place to intentionally induce a fast heart rate, learning to tolerate the sensation.

    CBT for Anxiety in Autistic Youth

    Generalized anxiety, social anxiety, and phobias are common in autistic children. Adapted CBT tackles these with:

    1. Emotion Recognition and Regulation: Many autistic children struggle to identify and label their emotions. CBT works on building emotional literacy through visual aids, emotion cards, and practice scenarios.
    2. Identifying Triggers: Helping the child and family identify specific situations, sensory inputs, or changes in routine that trigger anxiety. Creating “anxiety trigger lists” or visual maps can be helpful.
    3. Coping Skills Development: Teaching a repertoire of coping strategies, often on behaviour cards:
    4. Sensory Strategies: Deep pressure, fidget toys, sensory breaks, “sensory toolbox.”
    5. Relaxation Techniques: Progressive muscle relaxation, guided imagery (often using scripts tailored to special interests).
    6. Problem-Solving Skills: Breaking down overwhelming problems into smaller, manageable steps, using visual flowcharts.
    7. Exposure and Response Prevention (ERP): For phobias or obsessive-compulsive tendencies, gradual exposure to feared objects or situations, coupled with preventing avoidance or rituals, is highly effective. This is carefully planned and implemented with strong visual support.

    CBT for Depression in Autistic Youth

    Depression in autistic children and adolescents can present differently than in neurotypical peers, sometimes manifesting as increased irritability, stimming, withdrawal, or difficulty engaging in preferred activities. CBT for depression in this population focuses on:

    1. Behavioral Activation: Helping the child engage in activities that are enjoyable or provide a sense of accomplishment, even when they don’t feel motivated. This often involves creating structured visual schedules of activities.
    2. Cognitive Restructuring: Addressing negative thought patterns common in depression (e.g., “I’m a failure,” “No one likes me,” “Things will never get better”). This involves:
    3. Thought Records: Simplified visual templates for recording negative thoughts, identifying emotions, and challenging the thoughts with alternative, more balanced perspectives.
    4. “Thinking Traps” Cards: Visual representations of common cognitive distortions (e.g., “all-or-nothing thinking,” “catastrophizing”) with examples relevant to the child’s life.
    5. Social Skills Training: Since social isolation can contribute to depression, CBT may incorporate targeted social skills training, using role-playing, video modeling, and social stories to improve communication and interaction.
    6. Self-Monitoring: Encouraging the child to track their mood, energy levels, and engagement in activities using visual charts or apps. This helps them recognize patterns and the impact of their behaviors.
    7. Mindfulness and Self-Compassion: Adapting mindfulness exercises to be concrete and less abstract, focusing on sensory awareness in the present moment, and fostering self-kindness.

    Conclusion

    CBT, when thoughtfully and flexibly adapted, is a powerful tool in addressing panic attacks, anxiety, and depression in autistic children and adolescents. The judicious use of visual aids, concrete language, personalized examples, and a strong collaborative approach with families are crucial for success. By empowering autistic youth with practical strategies to understand and manage their internal experiences, CBT not only alleviates distressing symptoms but also fosters greater emotional regulation, independence, and overall well-being, enabling them to navigate the complexities of life with increased confidence.

  • Rewriting the Wound: Cognitive Reframing in Clinical Hypnotherapy

    Rewriting the Wound: Cognitive Reframing in Clinical Hypnotherapy

    In the quiet space between breath and belief, transformation can begin.

    As a trauma therapist and clinical hypnotherapist, I have witnessed time and again how memory is not static—it is alive, adaptive, and, when held gently, open to reformation. One of the most powerful techniques I use in clinical hypnotherapy is cognitive reframing: a process of re-authoring internal narratives so that they serve a healing purpose rather than harm.

    Cognitive reframing is not about erasing the past. It’s about shifting the lens through which we view it. And in hypnotherapy, where the subconscious becomes porous and receptive, this technique becomes effective and transformative.

    The Gut-Brain Axis: A Two-Way Street of Survival and Safety

    For clients living with chronic digestive conditions, understanding the gut-brain axis can be a decisive first step toward healing.

    The gut is often referred to as the “second brain” for good reason. Through a complex network of over 100 million neurons in the enteric nervous system (ENS), it maintains constant bidirectional communication with the brain via the vagus nerve, immune system, and endocrine signals. This connection is known as the gut-brain axis (GBA).

    When the brain perceives danger, whether through external stressors or internal trauma triggers, it sends alarm signals to the gut, disrupting motility, increasing inflammation, altering microbiota, and reducing nutrient absorption. The gut, in turn, sends feedback to the brain about its distress, often worsening anxiety and depression. This creates a self-reinforcing feedback loop between fear and inflammation, as well as memory and motility.

    In trauma survivors, especially those with early adverse experiences, the GBA becomes conditioned to expect threat. The gut remembers, even when the conscious mind cannot. Clinical hypnotherapy allows us to interrupt this loop at the subconscious level, where much of this conditioning resides.

    Cognitive Reframing as Nervous System Repair

    Cognitive reframing, when used in a hypnotic trance state, does not simply offer new thoughts—it provides new biological instructions to the gut-brain communication system.

    By helping the client generate new subconscious beliefs, such as:

    1. “I am safe in my body,”
    2. “My digestive system knows how to restore balance.”
    3. “I do not have to brace for pain anymore,”

    We begin to down-regulate the sympathetic nervous system, allowing parasympathetic functions like digestion, repair, and cellular healing to resume.

    Hypnotic suggestions can also influence the vagal tone, enhancing vagal flexibility, which is crucial for reducing gastrointestinal hypersensitivity and promoting calm peristalsis. This is particularly effective in conditions like IBS, ulcerative colitis, Crohn’s disease, and non-celiac gluten sensitivity, where stress exacerbates symptoms.

    Case Example: From Hypervigilance to Gut Resilience

    A 29-year-old Ghanaian American woman came to me after years of undiagnosed GI pain, multiple colonoscopies, and mounting anxiety around food. She said, “My gut doesn’t trust me. And I don’t trust it.”

    Through clinical hypnotherapy, we accessed an early memory of her hiding during a family conflict, too scared to breathe, too scared to move. Her gut had frozen with her. The narrative we reframed became:

    “That freeze saved you then, but you are not in that room anymore. Your gut is safe now. It’s allowed to move.”

    She repeated this affirmation under trance, accompanied by visualizations of fluid digestive rhythms and a protective inner caregiver figure. Within three months, she reported significantly fewer flares, returned to shared meals, and even began cooking again—something she had abandoned for years.

    Why Hypnosis Accelerates Gut Healing

    Traditional cognitive behavioral therapy (CBT) can be limited by the cognitive load it requires. But in hypnosis, the conscious mind relaxes, allowing suggestions and metaphors to bypass analytical filters and directly influence the body’s internal “control panels.”

    Cognitive reframing in this state becomes more than mental rewording—it becomes cellular reorientation. The gut hears. The body believes.

    And most importantly, the client begins to reclaim agency over their body’s story.

    Ethical Considerations

    Cognitive reframing is never about gaslighting the body or dismissing pain. We honor the symptom. We acknowledge the suffering. But we ask the subconscious, “What if this isn’t the only story? What else could be true?”

    In this way, reframing becomes an act of reclamation, not erasure. Especially for those who have been misdiagnosed, disbelieved, or medicalized without being heard, this shift can be life-altering.

    Final Reflections

    In every session where I integrate hypnotherapy with somatic listening, I’m reminded that healing is not a linear path—it’s a spiraling return to safety. When the gut and brain begin to communicate in new ways, the entire body listens differently.

    Cognitive reframing within hypnotherapy is not just a technique. It is a form of spiritual neuroscience. It is trauma-informed biology. It is the practice of speaking softly enough that the body finally feels safe to respond.

    Let us continue to speak those softer truths—

    until even the gut knows:

    I am no longer in danger.

    I am healing now.

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    Bennett, E. J., Tennant, C. C., Piesse, C., Badcock, C. A., & Kellow, J. E. (1998). Level of chronic life stress predicts clinical outcome in irritable bowel syndrome. Gut, 43(2), 256–261. https://doi.org/10.1136/gut.43.2.256

    Bonaz, B., Bazin, T., & Pellissier, S. (2018). The vagus nerve at the interface of the microbiota-gut-brain axis. Frontiers in Neuroscience, 12, 49. https://doi.org/10.3389/fnins.2018.00049

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    Derogatis, L. R., & Wise, T. N. (2010). The psychosomatic assessment. Routledge.

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    Gureje, O., & Simon, G. E. (2008). The natural history of somatization in primary care. Psychological Medicine, 38(5), 575–580. https://doi.org/10.1017/S0033291707001909

    Kearney, D. J., & Brown-Chang, J. (2008). Complementary and alternative medicine for IBS in adults: Mind–body interventions. Nature Clinical Practice Gastroenterology & Hepatology, 5(11), 624–636. https://doi.org/10.1038/ncpgasthep1248

    Kinsinger, S. (2017). Cognitive-behavioral therapy for patients with irritable bowel syndrome: Current insights. Psychology Research and Behavior Management, 10, 231–237. https://doi.org/10.2147/PRBM.S124090

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  • Effective CBT Therapy Requires Therapist Rational Thinking

    Effective CBT Therapy Requires Therapist Rational Thinking

    As president of the NACBT, I am very motivated to encourage the practice of Effective CBT. When I was in graduate school in the mid-1980s, Raymond Corsini claimed in his book, Current Psychotherapies, that at least 450 approaches to psychotherapy existed at that time. That is at least 450 different options from which potential clients may choose. Additionally, of course, there are many therapists whose practice does not resemble a recognized approach whatsoever.

    The cognitive-behavioral therapies are well-known for being unique in a variety of ways. CBT approaches:

    Are based on the cognitive model of emotional response;

    Are briefer and time-limited;

    Emphasize that a sound therapeutic relationship is necessary for effective therapy, but not the focus;

    Emphasize a collaborative effort between the therapist and the client;

    Are based on aspects of Stoic philosophy;

    Utilize the Socratic Method;

    Are structured and directive;

    Are based on an educational model;

    Rely on the Inductive Method.;

    Emphasizes the important role of homework. (For more information, please visit: https://www.nacbt.org/whatiscbt-htm/

    However, no approach to psychotherapy requires rational thinking on the therapist’s part more than the CBT approaches. Effective CBT requires rational thinking on the therapist’s part, as well as a strong belief in its tenets. This fact is problematic when we consider that therapists are human beings who both learn and are capable of developing their own irrational thoughts. It is also problematic given the fact that the professional mental health field attracts people who possess various disturbances in the hopes of healing themselves through their studies.

    After at least 30 years of training and supervising therapists (hundreds of thousands, that is), I can assure you that self-healing through the graduate study of counseling/psychotherapy usually does not work. Some of the most disturbed people I have ever met have been therapists.

    So how does irrational thinking on the therapist’s part interfere with effective CBT?

    1. Therapists’ irrational thinking leads them to believe that the ABCs of Emotions apply to some emotional reactions, but not all.

    For example, they believe that the ABC model applies to one’s angry reaction to being mistreated by one’s boss, but it does not apply to one’s reaction to having been raped. I have found that a main reason for that assumption is that the therapist has a sensitivity to the issue of rape. Perhaps they were raped themselves. When therapists hold to this erroneous assumption, they will necessarily inhibit the client’s healing as they will either directly state, or indirectly imply, that since the rape itself is causing the client’s distress, they will always have difficulty with it to some degree.

    However, rational therapists understand that the ABCs of Emotions apply to all learned emotions and behaviors. In the case of rape, we seek to understand the meaning that the person has attached to the event. Why does the client continue to make himself or herself miserable over the event? It’s because of what they assume having been raped will mean for their present and future. If they assumed that it would have no impact whatsoever on the rest of their life, they likely would compartmentalize it as a very unfortunate experience for which they are thankful it is over.

    2. Therapists’ irrational thinking leads them to think that they must experience what the client has experienced to be helpful to the client.

    Frankly, sometimes what comes out of the mouths of therapists is not much different than what is expressed by many clients. During a recent training, when I taught about distress intolerance and the fact that panic is ONLY unpleasant and uncomfortable, NOT unbearable or life-threatening, a therapist asked me, “Have you ever had a panic attack?” That led me to suspect that the trainee most likely tended to panic herself. My suspicion was confirmed by her.

    Rational therapists recognize that accurate empathy is NOT attempting to discover how the therapist would feel “in the client’s shoes.” Accurate empathy is working to understand how the client feels in his or her shoes. If the therapist has experienced something similar to the client’s experience, the therapist runs the risk of projecting his or her experience onto the client.

    3. Therapists’ irrational thinking causes them to overlook the client’s irrational thoughts.

    A client seeks therapy because they are painfully shy. Their reluctance to be around people is based on the belief that they must have everyone’s approval, yet they doubt that others will view them favorably. However, the therapist maintains the same irrational belief. What is the therapist likely to do in this situation? THE THERAPIST WILL AGREE WITH THE CLIENT! As a result, one of the two people in that situation is useless, and it is not the client.

    Therapists who strive to perform effective cognitive-behavioral therapy must learn how to recognize irrational thoughts and apply that knowledge to their own cognitions. We need to work at eliminating our own irrational thoughts so that we may be in the best possible position to help the client recognize his or her own.

    Rational therapists recognize that rational self-counseling is a life-long process and that we can always improve our ability to think and behave rationally. But doing so, our clients will benefit from our increased ability to recognize their irrational thoughts and to help them correct them.

    For more information on training opportunities in CBT, please visit: https://cbtonlinetraining.com

  • What is CBT (Cognitive-Behavioral Therapy)?

    What is CBT (Cognitive-Behavioral Therapy)?

    by Dr. Aldo Pucci

    Cognitive-behavioral therapy (cognitive behavior therapy) does not exist as a distinct therapeutic technique. The term “cognitive-behavioral therapy” is a very general term for a classification of therapies with similarities. There are several approaches to cognitive-behavioral therapy, including Rational Emotive Behavior Therapy, Rational Behavior Therapy, Rational Living Therapy, Cognitive Therapy, and Dialectic Behavior Therapy.

    However, most cognitive-behavioral therapies have the following characteristics:

    1. CBT is based on the Cognitive Model of Emotional Response.

    Cognitive-behavioral therapy is based on the idea that our thoughts cause our feelings and behaviors, not external things, like people, situations, and events. The benefit of this fact is that we can change how we think to feel/act better even if the situation does not change.

    2. CBT is Briefer and Time-Limited.

    Cognitive-behavioral therapy is considered among the most rapid in terms of results obtained. The average number of sessions clients receive (across all types of problems and approaches to CBT) is only 16. Other forms of therapy, like psychoanalysis, can take years. What enables CBT to be briefer is its highly instructive nature and the fact that it makes use of homework assignments. CBT is time-limited in that we help clients understand at the very beginning of the therapy process that there will be a point when the formal therapy will end. The ending of formal therapy is a decision made by the therapist and client. Therefore, CBT is not an open-ended, never-ending process.

    3. A sound therapeutic relationship is necessary for effective therapy, but not the focus.

    Some forms of therapy assume that the main reason people get better in therapy is because of the positive relationship between the therapist and the client. Cognitive-behavioral therapists believe it is important to have a good, trusting relationship, but that is not enough. CBT therapists believe that the clients change because they learn how to think differently and they act on that learning. Therefore, CBT therapists focus on teaching rational self-counseling skills.

    4. CBT is a collaborative effort between the therapist and the client.

    Cognitive-behavioral therapists seek to learn what their clients want out of life (their goals) and then help their clients achieve those goals. The therapist’s role is to listen, teach, and encourage, while the client’s roles is to express concerns, learn, and implement that learning.

    For excellent cognitive-behavioral therapy self-help and professional books, audio presentations, and home-study training programs, please click here.

    5. CBT is based on aspects of stoic philosophy.

    Not all approaches to CBT emphasize stoicism. Rational Emotive Behavior Therapy, Rational Behavior Therapy, and Rational Living Therapy emphasize aspects of stoicism. Beck’s Cognitive Therapy is not based on stoicism.

    Cognitive-behavioral therapy does not tell people how they should feel. However, most people seeking therapy do not want to feel the way they have been feeling. The approaches that emphasize stoicism teach the benefits of feeling, at worst, calm when confronted with undesirable situations. They also emphasize the fact that we have our undesirable situations whether we are upset about them or not. If we are upset about our problems, we have two problems — the problem, and our upset about it. Most people want to have the fewest number of problems possible. So when we learn how to more calmly accept a personal problem, not only do we feel better, but we usually put ourselves in a better position to make use of our intelligence, knowledge, energy, and resources to resolve the problem.

    6. CBT uses the Socratic Method.

    Cognitive-behavioral therapists want to gain a very good understanding of their clients’ concerns. That’s why they often ask questions. They also encourage their clients to ask questions of themselves, like, “How do I know that those people are laughing at me?” “Could they be laughing about something else?”

    7. CBT is structured and directive.

    Cognitive-behavioral therapists have a specific agenda for each session. Specific techniques / concepts are taught during each session. CBT focuses on the client’s goals. We do not tell our clients what their goals “should” be, or what they “should” tolerate. We are directive in the sense that we show our clients how to think and behave in ways to obtain what they want. Therefore, CBT therapists do not tell their clients what to do — rather, they teach their clients how to do.

    8. CBT is based on an educational model.

    CBT is based on the scientifically supported assumption that most emotional and behavioral reactions are learned. Therefore, the goal of therapy is to help clients unlearn their unwanted reactions and to learn a new way of reacting.

    Therefore, cognitive-behavioral therapy has nothing to do with “just talking”. People can “just talk” with anyone.

    The educational emphasis of CBT has an additional benefit — it leads to long-term results. When people understand how and why they are doing well, they know what to do to continue doing well.

    9. CBT theory and techniques rely on the Inductive Method.

    A central aspect of Rational thinking is that it is based on fact. Often, we upset ourselves about things when, in fact, the situation isn’t like we think it is. If we knew that, we would not waste our time upsetting ourselves.

    Therefore, the inductive method encourages us to look at our thoughts as being hypotheses or guesses that can be questioned and tested. If we find that our hypotheses are incorrect (because we have new information), then we can change our thinking to be in line with how the situation really is.

    10. CBT emphasizes the important role of homework.

    If a person wants to learn a musical instrument well enough to perform in a band, they will need to play that instrument more than during their weekly lesson. Daily practice will produce the learning and ability they seek.

    The same is the case with psychotherapy. Goal achievement (if obtained) could take a very long time if a person were only to think about the techniques and topics taught for one hour per week. That’s why CBT therapists assign reading assignments and encourage their clients to practice the techniques learned.